IS RENAL IMPAIRMENT CONCEALED IN ELDERLY DIABETICS????

Objective: To compare and evaluate the renal profile of elderly and younger diabetics.Methods: This cross sectional study was conducted in a tertiary care teaching hospital. Patients with type-2-diabetes were grouped into elderly (age≥60years) and younger diabetics. Patients' demographics, duration of diabetes and serum creatinine were recorded. Cockcroft-Gault formula was used to calculate creatinine clearance (Clcr). Statistical analysis was done using Students'‘t' test and Pearson's correlation. Regression analysis to adjust for covariables was done wherever required.Results: A total of 477 diabetics were included (elderly n=320, young n=157). Body mass index (BMI) was significantly lower (p=0.003) and duration of diabetes was significantly longer (p=0.001) among elderly. Significant difference was noted in serum creatinine (1.06±0.32 vs 0.95±0.29 mg/dl; p=0.0002) and Clcr (57.82±17.41 vs 88.07±24.60 ml/min; p=0.001) between elderly and younger diabetics. Only 4.7% of elderly, whereas 47.8% of young had normal Clcr. Clcr showed a negative correlation with age in elderly (r=-0.389, p<0.001) and young (r=-0.396, p<0.001) and positive correlation with BMI in elderly (r=0.401, p<0.001) and young(r=0.337, p<0.001). Regression analysis of Clcr in elderly and young showed a positive correlation for BMI and inverse relationship for age and duration of diabetes mellitus.Conclusion: Almost 95% of the elderly and 50% of younger diabetics had impaired creatinine clearance. Renal impairment was concealed in most of them since mean serum creatinine was 1 mg/dl. Indian elderly diabetics should be considered renally impaired and drugs for all conditions need adjustment for creatinine clearance

IS DOSE TITRATION REQUIRED FOR ANTIHYPERTENSIVE AGENTS IN GERIATRIC DIABETIC PATIENTS?

Objective: The objective of this study is to evaluate the antihypertensive drug usage and dosage differences between geriatric and non-geriatric diabetics with reference to the duration of hypertension and creatinine clearance (Crcl).Methods: In this observational study, patients with type 2 diabetes mellitus were grouped into geriatric (age ≥60 years) and non-geriatric (age <60 years). Patients' demographic data, duration of hypertension, drugs prescribed, and serum creatinine were recorded after the patients had a stabilized antihypertensive dose for 6 months. Crcl was calculated using Cockcroft–Gault formula. The dosages of antihypertensives were converted into equivalent doses for easy comparison within a group. For angiotensin-converting enzyme inhibitors (ACEIs), enalapril was considered as prototype, and for angiotensin receptor blockers (ARBs) losartan, beta-blocker atenolol, and calcium channel blockers (CCBs), amlodipine was considered as prototype. Univariate analysis was done for comparison of drug doses between groups.Results: A total of 336 diabetics with hypertension were included, of which 252 were geriatric and 84 non-geriatric. Duration of hypertension was expectedly longer in the geriatric group (8.40±7.26 vs. 5.46±5.67; p=0.001). Systolic blood pressure was higher in geriatrics (137.14±13.51 vs. 133.38±12.49; p=0.01). When adjusted for the duration of hypertension and Crcl, there were no significant differences in the mean converted equivalent doses of beta-blockers, CCBs, ARBs, and hydrochlorothiazide between geriatrics and non-geriatrics. However, statistically significant lower converted equivalent doses of all ACEIs were needed in geriatrics compared to non-geriatrics, when adjusted for duration of hypertension and Crcl. Enalapril required 20.57% and ramipril required 18.36% dose reduction in geriatrics compared to non-geriatrics.Conclusion: A 20% dosage reduction is needed for ACEIs in the elderly

Letter to the Editor

Background Challenges of 21st century are not only to combat infectious diseases but also to recognize many causes of ill-health that are related to lifestyle, man-made changes in the environment, and disparity and inequality in resources allocation within and between the countries. Now lifestyle diseases are becoming one of the major threat in developing countries apart from communicable diseases, maternal & perinatal diseases. Method Community-based, cross-sectional study Results Overall prevalence in the present study is 21.0% in rural area. Hypertension is higher in male population in (22%) as compared to female population. The prevalence of hypertension is increased with age in both sexes which is statistically highly significant (